Healthcare Provider Details

I. General information

NPI: 1144131319
Provider Name (Legal Business Name): CORNERSTONE COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 N LINCOLN AVE
CHICAGO IL
60625-2421
US

IV. Provider business mailing address

5230 N LINCOLN AVE
CHICAGO IL
60625-2421
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-6396
  • Fax:
Mailing address:
  • Phone: 773-506-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANDREW WINTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-858-0497